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This chapter discusses the case of a 42-year-old patient who was admitted for the evaluation of opioid-induced central sleep apnea. It presents the clinical history, examination, follow-up, treatment, and the results of the procedures performed on the patient. The patient was presented for evaluation of frequent breathing pauses during sleep, which had been witnessed by his wife for 5 years along with intermittent mild snoring. His social history was negative for alcohol or other substance abuse, but he was an ex-smoker and he drank 12 cups of coffee per day. The patient had been maintained on narcotics for treatment of his chronic pain following the laminectomy, for a period of 8 years. In view of his sleep respiratory symptoms, polysomnography (PSG) was performed. Opioid-induced central sleep apnea (CSA) has attracted attention in recent years because of the surge in opioid administration to patients with pain.
This chapter discusses the case of a 27-year-old male who was admitted to the hospital with right arm numbness. It presents the clinical history, examination, follow-up, diagnosis, and the results of the procedures performed on the patient. Physical examination showed a fixed left pupil and a Babinski response bilaterally. The diagnosis was hypersomnia with paroxysmal sleep associated with acute bilateral paramedian thalamic infarction, classified as hypersomnia of central origin. The thalamus has numerous connections with other areas of the brain as well, and these are thought to be important in the integration of cerebral, cerebellar and brainstem activity. The differential diagnosis includes the "top of the basilar artery" syndrome, where infarctions tend also to involve the territories supplied by the superior cerebellar and posterior cerebral arteries, and the occlusion of multiple vascular territories or other pathological conditions such as vasculitis or infectious disease.
This chapter presents the case study of a male adult sleepwalker with recurrence of sleepwalking events previously suffered in childhood. It describes the clinical history, examination, and the results of the procedures performed and the results obtained. He had a history of sleep-walking in childhood but stopped exhibiting events after the age of 14 years. The patient underwent polysomnography (PSG) because the episodes were frequent, violent and potentially dangerous to his wife. He had had 40 hours sleep deprivation previously. A diagnosis of sleepwalking (somnambulism) was made. Sleep deprivation and irregular hours were the main triggers of recurrence of sleepwalking in this patient. The PSG was also important to exclude the presence of concurrent sleep disorders such as sleep apnea and periodic limb movement disorder (PLMD), as both conditions can precipitate sleepwalking events by producing sleep instability secondary to arousals.
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